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Infectious Disease > Fungal Infections- Exam 2 > Flashcards

Fungal Infections- Exam 2 Flashcards

1
Q

______ common, normal flora that can become an opportunistic pathogen. What is the MC type?

A

Candidiasis

Candida albicans

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2
Q

What are some risk factors for Candidiasis?

A

Chronic disease - chronic kidney disease, cancer, HIV, DM
Medications - corticosteroids, immunosuppressants, broad-spectrum abx
Vascular access - IV drug use, intravascular catheters
Other - recent surgery (especially abdominal), prolonged neutropenia, organ transplant

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3
Q

Candidiasis of the _____ and _____ or the _____ are AIDS-defining opportunistic infections!

A

mouth

esophagus

lower respiratory tract

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4
Q

______ often seen especially in infants, elderly, DM pts, immune deficiency, or after use of meds like antibiotics/steroids

A

Oral Candidiasis

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5
Q

Beefy red, edematous mucosa of oral cavity
+/- white plaques on tongue, palate, buccal mucosa, oropharynx
Plaques can be scraped off with a tongue depressor
What am I?

A

Oral Candidiasis

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6
Q

How is Oral Candidiasis diagnosed?

A

Often can diagnose clinically
KOH prep - budding yeasts, pseudohyphae
Culture - + for candidal species - more accurate, longer to results

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7
Q

What is the topical treatment for oral candidiasis?

A

Nystatin (100,000 U/mL) - 5 mL (1 tsp) swish and swallow 4x/day
Clotrimazole troches (10 mg) - 1 troche dissolved orally 5x/day
Miconazole buccal tablet (50 mg) - 1 tablet applied QD

for 7-14 days

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8
Q

What is the systemic treatment for oral candidiasis?

A

Fluconazole (Diflucan) 200 mg - 1 PO QD
May cut down to 100 mg after day 1

for 7-14 days

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9
Q

What is the alternative treatment for oral candidiasis?

A

Gentian Violet x 3 days

usually commonly in babies

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10
Q

Esophageal candidiasis is often seen in what type of pt population?

A

typically in HIV + or other severely
immunosuppressed pts; often also have oral thrush

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11
Q

odynophagia, nausea, reflux, +/- oral thrush

What am I?

How do you diagnosis?

A

Esophageal Candidiasis

endoscopy

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12
Q

What is the treatment for Esophageal Candidiasis?

A

Fluconazole (Diflucan) - 400 mg on day 1, then 200-400 mg daily for 14-21 d

Itraconazole (Sporanox) - if resistant to or intolerant of fluconazole
More costly, more nausea, must use solution rather than tablet

OR

IV : Fluconazole (Diflucan) - 400 mg on day 1, then 200-400 mg daily for 14-21 d
If resistant to fluconazole - voriconazole, posaconazole, or an echinocandin

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13
Q

itching, burning, and/or pain around genital area, dyspareunia. thick, white, nonmalodorous, “cottage cheese”. with NO ordor. very itchy

A

Vulvovaginal Candidiasis

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14
Q

What are some risk factors that increase the rate of Vulvovaginal Candidiasis?

A

HIV, pregnancy, antibiotic use, uncontrolled DM all up the risk

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15
Q

How do you diagnosis Vulvovaginal Candidiasis?

A

clinically!

can do KOH prep and culture but not normally

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16
Q

Which vulvovaginal candidiasis treatment comes in ointment form?

A

terconazole (Terazol) so it stings less when applied

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17
Q

What is the topical treatment for Vulvovaginal Candidiasis?

A

1, 3, and 7 day regimens available - rx or OTC
Miconazole (Monistat), clotrimazole (Mycelex), terconazole (Terazol)

NEEDS TO BE DOSED AT BEDTIME to prevent leakage

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18
Q

What is the systemic treatment for Vulvovaginal Candidiasis?

A

Fluconazole (Diflucan) 150 mg - 1 PO x 1 dose
Ibrexafungerp (Brexafemme) 150 mg - 2 PO BID x 2 doses (300 mg q 12 hr)

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19
Q

What is the prophylactic treatment for Vulvovaginal Candidiasis? Alternative?

A

Azoles - topical PV 1x/week or fluconazole 150 mg 1 PO 1x/wk
Probiotics - questionable benefit, but little harm

Gentian Violet x 1 application, Boric Acid PV x 7 days

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20
Q

______ candida grows well in warm, moist environments (skin folds)

A

Candidal Intertrigo

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21
Q

What are some risk factors for developing Candidal Intertrigo? Commonly seen where?

A

obesity, occlusive or tight clothing, sweating, incontinence, DM, immunosuppression, medications

beneath breasts, armpits, inguinal fold, pannus, diaper rash

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22
Q

Erythematous, macerated, well-defined plaques in skin folds
Satellite erythematous papules and pustules
Well defined border with clear transition from red rash to non-effected skin

A

Candidal Intertrigo

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23
Q

How do you dx Candidal Intertrigo?

A

clinically!!!
can do
KOH prep (skin scrapings) - budding yeasts, pseudohyphae
Culture - + for candidal species - more accurate, longer to results

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24
Q

What is the treatment for Candidal Intertrigo?

A

Weight loss, controlling DM, wearing different clothing, etc.
Drying agents - talc, nystatin powder

Topical azoles or nystatin, BID until resolution (usually within 2 weeks)

systemic therapy if severe: Fluconazole 50-100 mg daily or 150 mg once weekly x 2-6 weeks

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25
Q

Tinea capitis is found on the ____

A

scalp

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26
Q

tinea corporis is found on the ____

A

body (ringworm)

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27
Q

tinea cruris is found on the ____

A

groin (jock itch)

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28
Q

tinea pedis is found on the _____

A

feet- athlete’s foot

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29
Q

tinea versicolor is found on the _____

A

body- pityriasis versicolor but is not a true tinea and is a dermatophyte

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30
Q

tinea unguium is found on the ____

A

nail- onychomycosis

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31
Q

superficial mycoses feed off ____. What will a KOH prep reveal?

A

keratin on the infected skin, nails and hair

segmented hyphae

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32
Q

Single or multiple scaly, circular patches on scalp
Alopecia; may see “black dots” at follicles
(broken-off hairs)
Patches slowly enlarge over time
What am I?
What pt population is it most commonly seen in?

A

Tinea Capitis

primarily seen in children

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33
Q

How is tinea capitis dx?

A

clinically
KOH prep and/or culture - usually only in
ambiguous/refractory cases

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34
Q

pruritic, erythematous, scaling, circular or
oval plaque
Center of lesion clears, while a raised, advancing,
scaly red border remains

What am I?
How is it spread?
How it is dx?

A

Tinea Corporis- ringworm

person-to-person and usually contracted from an animal

clinical presentation, can do KOH prep and culture if unsure

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35
Q

____ is much more common in males. Asymptomatic or itchy
Confined to groin and gluteal cleft
Erythematous lesions with scaly, sharp, spreading
margins; may have central clearing

A

Tinea Cruris

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36
Q

What are some risk factors for Tinea Cruris? How do you dx?

A

obesity, DM, immunodeficiency, sweating

clinically

KOH prep/culture

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37
Q

______ teens and adults especially males; seen often in athletes
Spread by contact with spores shed from infected individuals
Shared showers, locker rooms, floors around public pools
May also have tinea cruris, tinea manuum, tinea unguium

A

Tinea Pedis

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38
Q

Acute exacerbations are self-limiting, but recurrent - often triggered by increased sweating
Will continue indefinitely without treatment!
Itching, burning, stinging of the toes and feet
Erythematous bullae (acute) → scaling, fissuring, macerated skin, thickened plaques

What am I?
How do you dx?

A

Tinea pedis

clinically
KOH prep/culture

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39
Q

Where do you want to take a swab/prep from if you suspect tinea pedis?

A

on a not serious looking part

May be falsely negative if taken from macerated skin

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40
Q

What are some risk factors for tinea unguium?

A

elderly, swimming, tinea pedis,
immunocompromised, DM, psoriasis

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41
Q

thickened nail with
yellowish or brownish discoloration; may separate
from nail bed

What am I?
How do you diagnosis?

A

Tinea Unguium

KOH prep and/or culture
recommended to r/o other nail disorders

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42
Q

What is the treatment for tinea capitis?

A

griseofulvin, terbinafine; may consider fluconazole, itraconazole

griseofulvin is first line but some peds dont use it because of the SE and labs that need to be monitored

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43
Q

What is the treatment for tinea corporis?

A

Topical - azole, butenafine, tolnafate, ciclopirox, or terbinafine QD-BID until cleared (1-3 wks)

Systemic - extensive or refractory - griseofulvin, terbinafine, fluconazole, itraconazole

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44
Q

What is the treatment for tinea cruris?

A

Topical - azole, butenafine, tolnafate, ciclopirox, or terbinafine until cleared (1 wk); medicated drying powders

Systemic - extensive or refractory - griseofulvin, terbinafine, fluconazole, itraconazole

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45
Q

What is the treatment for tinea pedis? What if it is macerated?

A

Topical - azole, butenafine, tolnafate, ciclopirox, or terbinafine

If macerated - consider adding aluminum subacetate soaks 20 min BID

Systemic - extensive or refractory - terbinafine, itraconazole, fluconazole, griseofulvin

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46
Q

What is the treatment for tinea unguium?

A

Topical - efinaconazole, tavaborole, or ciclopirox
Systemic - terbinafine, itraconazole

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47
Q

_____ does NOT work on superficial mycoses infection aka tinea

A

nystatin

only works on candiasis infections

48
Q

______ candidemia; may be due to C. albicans or other strains. Severely immunocompromised state; nosocomial infection

A

Disseminated Candidiasis

49
Q

Varies greatly - minimal fever to septic shock
May see skin lesions ranging from pustules to nodules
May involve liver, kidney, spleen, eyes, heart

What am I? Dx?
What is the treatment?

A

Disseminated Candidiasis

blood cultures only + 50% of the time

First line: IV Echinocandins
Capsofungin IV

Mild/moderate disease: fluconazole
must continue for 2 weeks after their last positive blood culture

50
Q

What is the MC fungal infection in the brown area?

A

Blastomycosis

51
Q

What is the MC fungal infection in the yellow/gold area?

A

coccidioidomycosis

52
Q

What is the MC fungal infection in the blue area?

A

Histoplasmosis

53
Q

What is the MC fungal infection in the purple/pink area?

A

cryptococcus gattii

54
Q

_______ inhaled spores from contaminated bird and bat droppings. Begins in lungs, but spreads throughout the body

A

Histoplasmosis

55
Q

______ is caused by Histoplasma capsulatum

A

Histoplasmosis

56
Q

Where is histoplasmosis commonly found?

A

Primarily in river valleys (Ohio and
Mississippi River Valleys in US), but
present worldwide

57
Q

Fever, cough, myalgias, minor chest pain - almost never fatal
Mild flu-like illness to severe pneumonia - 1 week to 6 months
asymptomatic or mild; often found through incidental x-ray findings of pulmonary and/or splenic calcification; may see “eggshell” lymph node calcification

A

Histoplasmosis

58
Q

_____ often in epidemics after soil with bird or bat droppings is disturbed. think moving dirt around on a construction site

A

Acute pulmonary histoplasmosis

59
Q

In immunocompromised pts:
Fever, cough, dyspnea, weight loss, prostration, oropharyngeal ulcers
Multiple organ system involvement - hepatomegaly, splenomegaly, GI inflammation, adrenal insufficiency, bone marrow suppression, CNS infection
Can have fulminant, septic shock-like presentation progressing to death without tx

A

Progressive disseminated histoplasmosis

60
Q

What does the CXR of a pt with histoplasmosis look like?

A

Military infiltrates and mediastinal LAN

61
Q

What are the 4 major forms of histoplasmosis?

A

Acute pulmonary histoplasmosis
Chronic pulmonary histoplasmosis
Complications of histoplasmosis
Progressive disseminated histoplasmosis

62
Q

Older pts with underlying chronic lung disease
Pts are not necessarily immunosuppressed!

What am I?
What does the CXR look like?

A

Chronic pulmonary histoplasmosis

apical cavities, chronic infiltrates, pulmonary nodules

63
Q

_____ persistent mediastinal LAN and fibrosis of the mediastinum. Often seen in what condition?

A

Granulomatous mediastinitis

Complications of histoplasmosis

64
Q

Granulomatous mediastinitis
Leads to compromise of pulmonary vascular structures
Superior vena cava syndrome, esophageal constriction

What am I?

A

Complications of histoplasmosis

65
Q

What form of histoplasmosis?

A

acute pulmonary histoplasmosis with mild diffuse inflitration

66
Q

What form of histoplasmosis?

A

Disseminated Histoplasmosis with
diffuse interstitial alveolar infiltrates

67
Q

What form of histoplasmosis?

A

NONE!

its a normal CXR :)

68
Q

What form of histoplasmosis?

A

Calcified healed Histoplasmosis
(asymptomatic patient)

69
Q

What is the dx?

A

Fibrosing mediastinitis caused by scar tissue from the histoplasmosis

70
Q

What lab findings are common with histoplasmosis?

A

May see anemia of chronic disease, elevated LDH, ferritin, and/or AST

71
Q

Chronic disease histoplasmosis would want to order a _____

A

sputum culture

72
Q

disseminated histoplasmosis would want to order a _____

A

blood culture

73
Q

What is the most accurate diagnostic study for histoplasmosis?

A

bronchoscopy with biospy

74
Q

What is the treatment for mild/moderate histoplasmosis?

A

itraconazole (Sporanox), 200-400 mg/day (divided into BID dosing)

weeks to months

75
Q

What is the treatment for severe histoplasmosis?

A

IV amphotericin B

Granulomatous/Fibrosing Mediastinitis: may try itraconazole +/- rituximab, +/-

steroids and often times needs surgery

76
Q

______ Coccidioides immitis or Coccidioides posadasii AKA “Valley Fever”

A

Coccidioidomycosis

77
Q

_____ is transmitted through inhaled spores Grows in arid soil - southwest US,
Mexico, Central America
MC - immunocompromised, elderly
Suspect in patients who live or
work in endemic areas

A

Coccidioidomycosis

78
Q

What is the incubation period of Coccidioidomycosis?

A

10-30 days

79
Q

fever, chills, fatigue, HA, cough, myalgia
May see arthralgia and joint swelling (especially knees and ankles)
Rash (erythema nodosum) - may appear 2-20 days after s/s onset
What am I?
What does the CXR look like?

A

Coccidioidomycosis

infiltrate, cavities, abscesses, nodules, bronchiectasis - persist in 5%

80
Q

0.1% of white, 1% of nonwhite patients

Filipinos, blacks, pregnant women, and immunosuppressed at especially high risk

Worsened pulmonary s/s - mediastinal LAD, cough, increased sputum, lung abscesses
Multiorgan involvement - skin, bones, pericardium/myocardium, meningitis
Fungemia is possible; usually followed rapidly by death

What am I? What does the CXR look like?

A

Disseminated coccidioidomycosis

localized infiltrate, thin-walled cavities, pulmonary abscesses, nodules, mediastinal LAD, pleural effusion

81
Q

What is erythema nodosum secondary to ?

A

Coccidioidomycosis infection

82
Q

What is this? What is the underlying cause?

A

Erythema Nodosum secondary to Coccidioidomycosis infection

83
Q

What does the CXR look like on a pt with Coccidioidomycosis?

A

patchy, nodular and lobar upper lobe pulmonary infiltrates are MC

84
Q

What is the most reliable way to dx Coccidioidomycosis?

A

with biopsy and culture - most reliable method

85
Q

What additional labs might be positive with Coccidioidomycosis?

A

-may see leukocytosis, eosinophilia

May test for IgM and IgG complement fixation titer; possible to have false negatives

86
Q

What is the treatment for mild/moderate Coccidioidomycosis?

A

fluconazole or itraconazole for 4-12 weeks
May try voriconazole, posiconazole if refractory

87
Q

What is the treatment for severe/disseminated Coccidioidomycosis?

A

IV amphotericin B x 2-3 weeks, then switched to azole
Abscesses may need surgical management

88
Q

When would you treat someone prophylaxis for Coccidioidomycosis?

A

AIDS pts with CD4 count <250 will require maintenance therapy with an azole to prevent relapse

89
Q

______ inhaled spores
found in moist soil with decomposing
organic matter (wood and leaves)
MC seen in men infected during
outdoor activities for
occupation/recreation
South central and midwestern US
and Canada
Often occurs in immunocompetent (normal) pts

A

Blastomycosis

90
Q

______ is caused by Blastomyces dermatitidis

A

Blastomycosis

91
Q

chronic pulmonary infection
Flu-like - cough, moderate fever, dyspnea, chest pain
Extrapulmonary involvement - nodular, wart-like skin lesions
S/S may resolve or progress to pneumonia-like illness
purulent sputum production, pleurisy, fever,
chills, wt loss, prostration

What am I?

A

Blastomycosis

92
Q

Blastomycosis is asymptomatic in about ____ of cases?

A

50%

93
Q

Disseminated Blastomycosis is commonly found in ______ populations. Name some s/s

A

immunocompromised pts

Bone - ribs, vertebrae MC affected
GU - epididymitis, prostatitis, bladder irritation
Skin - may see nodular lesions as above

94
Q

In a urine antigen test, ____ has cross reactivity with Histoplasma

A

Blastomycosis

95
Q

What does the CXR look like in Blastomycosis?

A

airspace consolidation or masses are most common

96
Q

What labs finding are consistent with Blastomycosis?

A

may see leukocytosis, anemia

97
Q

Should also order ____ and _____ with blastomycosis

A

sputum cultures; blood cultures if disseminated

Bronchoscopy - with biopsy and culture

98
Q

What is the treatment for mild/moderate blastomycosis?

A

itraconazole (Sporanox) for 2-3 months

99
Q

What is the treatment for severe/CNS involvement blastomycosis?

A

IV amphotericin B

100
Q

____ are inhaled spores found in soil and pigeon dung. Clinically significant disease almost
always in immunocompromised pts

A

Cryptococcosis

101
Q

Cryptococcus neoformans is commonly found ____

A

worldwide

102
Q

Cryptococcus gattii is commonly found ______

A

tropical regions and Pacific NW

103
Q

Of the cyrptococcosis varieties _____ may be more likely to infect immunocompetent and more likely
to cause severe disease

A

C. gattii

104
Q

**____ is the MC cause of fungal meningitis

A

Cryptococcosis

105
Q

ranges from mild to respiratory failure
May see simple nodules or fever, cough, dyspnea, widespread infiltrates

A

Pulmonary Cryptococcosis

106
Q

HA followed by altered mental status, fever, CN abnormalities
Meningeal signs - often absent, especially in HIV+

A

cryptococcosis meningitis

107
Q

nodular lesions that may mimic bacterial cellulitis is often found in immunocompromised pts with _____

A

Cryptococcosis

108
Q

If you suspect Cryptococcosis want to order ????

A

serum: test for cryptococcal antigens
Cultures - sputum, blood, and/or urine cultures may be helpful
Bronchoscopy - with culture of sputum
CSF - budding, encapsulated yeast; + cryptococcal antigen

109
Q

What is the treatment for pulmonary Cryptococcosis?

A

fluconazole (Diflucan) for 6-12 months
HIV patients need continued suppressive therapy

110
Q

What is the treatment for Cryptococcosis meningitis?

A

IV amphotericin B plus flucytosine (if tolerated) x 2 weeks
Followed by 8 weeks of fluconazole
Frequent LP or CSF shunting to relieve high CSF pressure if needed

111
Q

_____ believed to have
airborne transmission
Most individuals have had asymptomatic
infection by a young age
Major patterns of clinical infection:
Epidemics among premature or debilitated
infants in underdeveloped countries
Sporadic cases among older children and adults
with impaired immunity
HIV/AIDS patients

A

Pneumocystosis

Pneumocystis jirovecii (worldwide

112
Q

P. carinii is now called _____

A

Pneumocystis jirovecii

aka Pneumocystosis

113
Q

_____ abrupt onset of fever, tachypnea, SOB, nonproductive cough
May or may not have bibasilar crackles on exam
Spontaneous pneumothorax is possible
Rapid deterioration and death if not treated

A

Pneumocystosis

114
Q

CXR will have diffuse interstitial infiltration; may also see consolidation, nodules, cavitations (5-10% of pts have normal xray)
NO CULTURES!!
Bronchoscopy - with special testing of respiratory specimens
Giemsa, methenamine silver, PCR, monoclonal antibody testing

A

Pneumocystosis

115
Q

What is the treatment for Pneumocystosis?

A

TMP-SMZ (Bactrim) is the drug of choice - x 14-21 days
HIV patients with CD4 <200 need continued suppressive therapy

116
Q

What is the 2nd line treatment for Pneumocystosis?

A

primaquine/clindamycin, trimethoprim-dapsone

117
Q
A

Infectious Disease (16 decks)

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